Background: Melanoma staging at diagnosis predominantly depends on the tumor thickness. Sentinel lymph node biopsy (SLNB) is a common tool for primary staging. However, for tumors of >4 mm with ulceration, 3D whole-body imaging and, in particular, Fluor-18-Deoxyglucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT), is recommended beforehand. This study aimed to investigate the real-world data of whole-body imaging for initial melanoma staging and its impact on the subsequent diagnostic and therapeutic procedures. Methods: In this retrospective single-center study, 94 patients receiving18F-FDG-PET/CT and six patients with whole-body computed tomography (CT) scans were included. The clinical characteristics, imaging results, and histologic parameters of the primary tumors and metastases were analyzed. Results: Besides the patients with primary tumors characterized as pT4b (63%), the patients with pT4a tumors and pT3 tumors close to 4 mm in tumor thickness also received initial whole-body imaging. In 42.6% of the patients undergoing18F-FDG-PET/CT, the imaging results led to a change in the diagnostic or therapeutic procedure following on from this. In 29% of cases, sentinel lymph node biopsy was no longer necessary. The sensitivity and specificity of18F-FDG-PET/CT were 66.0% and 93.0%, respectively. Conclusion: Whole-body imaging as a primary diagnostic tool is highly valuable and influences the subsequent diagnostic and therapeutic procedures in a considerable number of patients with a relatively high tumor thickness. It can help avoid the costs and invasiveness of redundant SLNB and simultaneously hasten the staging of patients at the time of diagnosis.
背景：黑色素瘤诊断分期主要取决于肿瘤厚度。前哨淋巴结活检（SLNB）是常用的初始分期工具。然而，对于厚度>4毫米且伴有溃疡的肿瘤，建议先行三维全身成像检查，特别是氟-18-脱氧葡萄糖正电子发射断层扫描联合计算机断层扫描（18F-FDG-PET/CT）。本研究旨在探讨全身成像在黑色素瘤初始分期中的实际应用数据及其对后续诊疗流程的影响。方法：本回顾性单中心研究共纳入94例接受18F-FDG-PET/CT检查的患者及6例接受全身计算机断层扫描（CT）检查的患者。对原发肿瘤及转移灶的临床特征、影像学结果及组织病理学参数进行分析。结果：除原发肿瘤分期为pT4b（63%）的患者外，pT4a分期及肿瘤厚度接近4毫米的pT3分期患者也接受了初始全身成像检查。在接受18F-FDG-PET/CT检查的患者中，42.6%的病例因影像学结果改变了后续诊疗方案。29%的病例因此无需再进行前哨淋巴结活检。18F-FDG-PET/CT的敏感性和特异性分别为66.0%和93.0%。结论：全身成像作为原发性诊断工具具有重要价值，对相当一部分肿瘤厚度较大的患者后续诊疗流程产生影响。该技术既能避免冗余SLNB带来的经济负担和侵入性操作，又能加速诊断时的分期进程。
Whole-Body Imaging for the Primary Staging of Melanomas—A Single-Center Retrospective Study
肿瘤(癌症)患者之家